Damage Control Laparotomy in Severe Blunt Abdominal Trauma: Assessing the Morbidity of Nonindicated Use and the Prognostic Role of Initial Serum Lactate

Abstract Background Damage control laparotomy (DCL) is lifesaving in physiologically exhausted trauma patients, but potentially avoidable use may increase morbidity. We evaluated outcomes of DCL performed without prespecified damage-control criteria for patients with severe blunt abdominal trauma (BAT) and the prognostic value of admission lactate. Methods Adults with abdominal AIS ≥ 4 undergoing emergency laparotomy from 2015–2024 were retrospectively analyzed. DCL and definitive laparotomy (DEF) were compared according to prespecified physiologic/anatomic criteria. Logistic and Firth penalized regression identified predictors of complications, prolonged ICU stay, and mortality; ROC analysis compared lactate with lethal-triad variables. Results Seventy-nine patients were included (DCL 31; DEF 48). Among 41 patients without prespecified criteria, 10 underwent DCL. Compared with DEF, the DCL subgroup had longer hospitalization (24.5 vs 14.0 days, p = 0.001) and more complications (50.0% vs 16.1%, p = 0.045); DCL remained associated with complications after adjustment for abdominal AIS (OR 5.7, 95% CI 1.1–30.6; p = 0.041). In the overall cohort, lactate independently predicted mortality (OR 1.20 per mmol/L, 95% CI 1.01–1.46; p = 0.043), whereas DCL predicted prolonged ICU stay (OR 4.14, 95% CI 1.10–15.62; p = 0.036). Lactate discrimination for mortality (AUC 0.731) exceeded the conventional lethal triad (AUC 0.614); optimal cutoff was 4.7 mmol/L. Conclusions DCL used without clear prespecified criteria was associated with greater morbidity and longer hospitalization for patients with severe BAT. Admission lactate may complement conventional physiologic criteria and support more selective trauma laparotomy decision-making.